Autism

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AUTISM SPECTRUM DISORDER Atta-Ur- Rehman , MD Instructor In P sychiatry Jefferson University Philadelphia, PA

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AUTISM SPECTRUM DISORDER Disclosures Dr. Rehman has no financial relationship or conflict of interest to disclose. Risperidone and Abilify – Approved for treatment of irritability within Autism. Other medication treatment considered off label.

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Learning Objective To learn and review the clinical presentation, epidemiology, clinical course evaluation and differential diagnosis of Autism. to learn and review the DSM IVTR diagnostic Criteria for Autism Spectrum disorder. To learn and review primary clinical standard and evidence based treatment both psychosocial and psychopharmacological for Autism Spectrum Disorder.

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What are we talking about? A group of Neurobiological Conditions Occur at some stage in child’s development often disrupting development

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History Literature Eugene Bleular Hans Asperger Leo Kanner Concept of Refrigerator mother Leo Kanner Hans Asperger Eugene Bleular

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ASD’S Autism Asperger Syndrome PDD NOS

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DIAGNOSTIC CRITERA DSM IV

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Qualitative impairment in social inter action, as manifested by two of the following: Marked impairment in the use of multiple , nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction Failure to develop peer relationships appropriate to developmental level A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing ,bringing or pointing out object of interest. Lack of social or emotional reciprocity Diagnostic criteria for 299.00 Autistic Disorder Total of six (or more) items from (1), (2), and (3) with at least two from (1), and on each from (2) and (3)

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Qualitative impairments in communication as manifested by at least one of the following: Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others. Stereotyped and repetitive use of language r idiosyncratic language Diagnostic criteria for 299.00 Autistic Disorder (contd.)

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Lack of varied, spontaneous make –believe play or social imitative play appropriate to developmental level Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by the at least one of the following: Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus Apparently inflexible adherence to specific, nonfunctional routines or rituals Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting , or complex whole body movements) Diagnostic criteria for 299.00 Autistic Disorder (contd.)

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Persistent preoccupation with parts of objects Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play The disturbance is better accounted for by Retts Disorder or Childhood Disintegrative Disorder. Diagnostic criteria for 299.00 Autistic Disorder (contd.)

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A lack of spontaneous seeking to share enjoyment , interest, or achievements with other people(e.g., by lack of bringing or pointing out objects of interest to other people) Lack of social or emotional reciprocity Marked impairment in the us of multiple nonverbal behaviors such ad eye-to-eye gaze facial expression, body, postures, and gestures to regulate social interaction Failure to develop peer relationships appropriate to developmental level Qualitative impairment in social interaction, as manifested by at least two of the following: Diagnostic criteria for 299.80 Asperger’s Disorder

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Diagnostic criteria for 299.80 Asperger’s Disorder (contd.) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus Persistent preoccupation with parts of objects Apparently inflexible adherence to specific , nonfunctional routines or rituals Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements)

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Diagnostic criteria for 299.80 Asperger’s Disorder (contd.) The disturbance causes clinically significant impairment in social , occupational, or other important areas of functioning. There is no clinically significant general delay in language (e.g. single word used by age 2 years, communicative phrases used by age 3 years) There is no clinically significant delay in cognitive development or in the development of age appropriate self-help skills, adaptive behavior (other than in social interaction) , and curiosity about the environment in childhood. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

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Symptoms with ASD Impaired development in social interactions Impaired development in communication Restricted repertoire of activity and interest

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Difference between Autism and Asperger No speech delay in Asperger Lack inflection Rhythmic nature Formal ( maybe too loud or high pitch) Not understand subtleties of language Cognitive Ability

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ETILOGY Genetic Environmental

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Epidemiology 1-2 / 1000 - (Autism) 6 / 1000 - (ASD) 3.7 / 1000 - (PDD NOS) 0.6 / 1000 - (Asperger) 4.3 - Boy 1 - Girl

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Epidemiology Age of either parent DM Bleeding Use of Psychiatric med Risk with older father

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Comorbidity Genetic disorder MR Seizure disorder Anxiety disorder Metabolic defects Preempted diagnosis Physical anomalies Sleep problems

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Diagnostic Instruments ADL-R ADOS CARS

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Differential DX MR Hearing Impairment Specific language impairment

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Treatment / Management A. Therapy ABA Developmental Model Structured teaching Speech / language therapy Occupational / Physical therapy Social skills therapy

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B. Medication Treatment is symptomatic Target symptoms Motor hyperactivity Repetitive behavior Aggression / self injury, property destruction Irritability Sleep issues Treatment / Management

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Medication (contd.) FDA approved: Risperdal Abilify Other Medications Stimulant SSRI Mood stabilizers Treatment / Management

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Prevalence Prognosis